Expert Point of View: Aaron Richard Hansen, BSc, MBBS (Hon), FRACP
Aaron Richard Hansen, BSc, MBBS (Hon), FRACP
“FOR THIS RARE tumor with a paucity of data, all we have are phase II trials to make treatment selection,” said invited discussant Aaron Richard Hansen, BSc, MBBS (Hon), FRACP, of the Princess Margaret Hospital, Toronto. “For patients with de novo metastatic disease or relapse after definitive treatment, treatment should be guided by performance status and previous treatment. Best supportive care is advised for patients not eligible for more treatment,” he explained.
“The best reported response rates are in the range of 30% to 40%. Since 2010, cisplatin-based regimens have been the most effective. Decisions between treatment regimens should be based on patient preferences and toxicities—and individualized. No potential predictive factors have been identified for penile cancer,” Dr. Hansen continued.
“Vinflunine is currently approved in Europe as a second-line option for bladder cancer based on a survival improvement of 2.4 months. Vinflunine is not approved by the U.S. Food and Drug Administration, nor is the drug widely used in North America,” Dr. Hansen noted.
“I CONGRATULATE the investigators for conducting a study on a rare cancer and wonder whether a clinical benefit rate is the optimal measure. The fact that 45% were not able to complete all 4 cycles of vinflunine raises the question of how this drug would perform in a real-world setting. The two deaths on study indicate we should be cautious in how we use this drug,” Dr. Hansen told listeners.
“Treatment options that are effective for penile cancer are rare. Although I cannot recommend vinflunine as a neoadjuvant chemotherapy regimen, I would be interested to see how it performs in a population with nonmetastatic disease who were cisplatin-ineligible. For patients with de novo metastatic disease who are not cisplatin candidates, or those whose disease progressed on cisplatin, vinflunine seems like an excellent alternative,” he stated. “It is important to make efforts to identify subpopulations of patients who may benefit from vinflunine and other chemotherapy regimens.” ■
DISCLOSURE: Dr. Hansen reported no conflicts of interest.
PENILE CANCER is rare, outcomes remain poor, and there are few data from randomized trials to guide treatment decisions. However, in the small phase II VinCaP study, presented at the 2018 Genitourinary Cancers Symposium, 45.5% of patients with advanced or metastatic penile cancer had a clinical...